CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Valley Presbyterian Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $149
Cash Discount Price: $165
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Valley Presbyterian Hospital is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.67x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$223.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $223.72 (100%)

Cash / Self-Pay: $165 (74%)

Insurance Median: $149 (67%)

Cash: $165 (74% of Medicare)

Ins. Median: $149 (67% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $223.72 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Shield Promise Medi-Cal	$34 - $262	15%
Cigna	$72 - $561	32%
Aetna	$77 - $598	34%
La Care Medi-Cal	$80 - $628	36%
Phcs	$80 - $628	36%
Coventry Health Care (Ccn)	$94 - $732	42%
UnitedHealthcare	$96 - $814	43%
Beech Street	$100 - $784	45%
Multiplan	$121 - $941	54%
Blue Shield Ifp	$133	59%
Blue Cross Blue Shield	$143 - $258	64%
Blue Shield	$150	67%
Blue Shield Senior	$253	113%
Health Net Senior	$258	115%
La Care Covered California	$258	115%
Medicare (plans)	$258 - $271	115%
Ambetter / Centene	$364	163%
Heritage Provider Network (Regal & Lakeside)	$401	179%
Health Net	$511	228%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $165.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 94640.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Valley Presbyterian Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 94640.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.